Mammograms are an important part of diagnosing breast cancer. But for women with disabilities, such a procedure can be traumatic when dealing with insensitive workers and inadequate equipment.
The Center for Disability Issues and the Health Professions (CDIHP) at Western University of Health Sciences in Pomona, Calif., is addressing these challenges by working with equipment manufacturers to modify mammography equipment and training health technicians.
This is an effort to help women with physical disabilities and mobility issues get equivalent breast screening, said June Kailes, MSW, LCSW, Associate Director of CDIHP. There is a documented disparity between women with and without disabilities in receiving screenings, she said.
“That gap can be bridged by attending to both the design of equipment as well as training of the technicians who do the screening,” Kailes said.
A mammogram is an X-ray photograph of the breast. The National Cancer Institute recommends that women age 40 and older should have screening mammograms every one to two years. Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.
As women age, they acquire arthritis, movement and mobility issues, Kailes said. By adjusting mammography equipment to accommodate these women, providers can market their products to health care providers as serving the broadest population possible, she said.
Obtaining marketing approval for a new medical device takes several years, and design changes are costly, Kailes said.
“It is likely that advocating for accessible design at the earliest point in the design process – at the conceptual stage – will be more successful and better received than attempting to ‘retrofit’ existing products to meet new accessibility requirements,” she said.
The medical device industry requires education about accessibility issues – both knowledge about the severity and extent of the problems and knowledge about the approaches and methodologies for ensuring that devices will be accessible to the maximum number and widest diversity of users, Kailes said.
“It is likely that flexible approaches will be necessary in different segments of the industry,” she said.
When health care advocates and policy leaders talk about access, they’re often talking about the ability of a patient to find a provider, and to find a provider willing to accept them and have available hours, said Chris Perrone, senior program officer with California Health Care Foundation, an independent philanthropy committed to improving the way health care is delivered and financed in California.
“What they don’t think about is the ability of that patient to access services through that provider, whether it’s a table that goes up and down so the person with the disability can get on the table, or get through the doors,” he said.
This broader view of access now resonates with health plans serving those beneficiaries, and they are working with CDIHP as they think about their provider networks and access there, Perrone said.
CDIHP wants to influence manufacturers’ thinking to create better designs and marketing, said Brenda Premo, MBA, Director of CDIHP. Also, training is important for those operating the equipment. And patients also need to explain to their doctors their accessibility needs.
“People aren’t mind readers,” Premo said. “This is the information you need. We educate technicians and we educate consumers.”
Some people who have mobility limitations are not referred to mammograms because of access issues, Premo said.
“Delayed diagnosis makes for more expansive and expensive treatment later, and sometimes with not good outcomes,” Kailes said.
CDIHP does a lot of work with hospitals and clinics in installing diagnostic, therapeutic, procedural, rehabilitation and exercise equipment, such as examination tables and modified gurneys and scales.
The center also educates workers about their role in providing health care access to people with disabilities. People come into the examination room with their own biases, but they must learn to put their attitudes in a box and leave it outside the door, Premo said.
“Even though we can’t make it go away, deal with it. Don’t impose bias on the facts of the case,” she said. “Hopefully they will change over time. As for now, put it away.”
Some people have the mistaken impression that health and disability cannot coexist, Kailes said. Sometimes these attitudes are unconscious. There is no magical way to change this, she said.
“Recognize bias, keep it in check so it doesn’t interfere with equitable access to health care,” Kailes said.